title: A new care paradigm in geriatric head and neck surgical oncology.
abstract: OBJECTIVE
  Perioperative management of elderly patients with head and neck cancer poses unique challenges. Our objective is to describe the implementation and feasibility of a novel intervention designed to improve perioperative care in geriatric head and neck surgery.
  
  
  METHODS
  This pilot study was performed in a single-institution, NCI-designated comprehensive cancer center. All surgical patients with head and neck cancer over age 75 were offered perioperative consultation with fellowship-trained geriatricians focusing in geriatric oncology.
  
  
  RESULTS
  Between 2010 and 2011, a total of 168 patients requiring head and neck surgery were seen by the geriatric service, of which 94% subsequently underwent surgery. Apart from preoperative medical optimization, geriatricians assisted in complex decision-making regarding the indications for cancer-directed therapy. Postoperatively, they assisted in preventing and treating delirium and poly-pharmacy, facilitating discharge planning, and initiating rehabilitation. Postoperatively, 87% were discharged home, and 13% required placement in skilled nursing facilities. At 24 months, overall survival was 80%. Patients, surgeons and geriatricians alike were enthusiastic about the initiative, which is expanding within the institution.
  
  
  CONCLUSIONS
  Geriatric perioperative support for elderly head and neck cancer patients is well-received with promising potential. The tangible impact and direct benefits of this pilot initiative require additional study.
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. shumana@mskcc.org
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.forename: Beatriz
authors.initials: B
authors.lastname: Korc-Grodzicki
authors.forename: Victoria
authors.initials: V
authors.lastname: Shklar
authors.forename: Frank
authors.initials: F
authors.lastname: Palmer
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D010351:Patient Discharge; D019990:Perioperative Care; D010865:Pilot Projects; D012017:Referral and Consultation; D012866:Skilled Nursing Facilities
keywords: geriatric oncology; head and neck cancer; preoperative care